Straight Talk on Managing Bipolar Disorder

I just received the following question from Alixana on how a person can know if an exciting and endorphin producing event can cause mania.  Here is the question and my long answer- I try to keep it short, but nothing with bipolar disorder is short!

Dear Julie,

Thank you for being so honest about your battle with bipolar disorder, and for chronicling your experiences so that other sufferers can learn from them.I stumbled upon your blog while googling for a link between endorphins and hypomania. So far, nothing I’ve read suggests that an endorphin rush can trigger off a hypomanic episode, but I’m worried that there might be a possible connection between the two.

 To cut a long story short, I took up social dancing a few months ago – at least two studies have shown that it benefits patients with depression, so I thought it’d help with bipolar as well (I have Bipolar II). I gradually realised that after social dancing, my thoughts would start racing, I’d be unable to sleep, and I’d be slightly more irritable in the couple of days following, even though I’m usually on cloud 9 immediately after a session. I didn’t take much notice of it and attributed it to other causes. However, I quickly became hypomanic at a dance party recently without even realising it. When I crashed back down to earth later, the realisation of how terribly and how uncharacteristically I’d behaved sent me straight into a depressive episode.

 I’m trying to figure out if there’s a direct link between endorphins (from dancing) and hypomania. Or is there another explanation for all this, so that I can still continue to dance. I’m seeing my psychiatrist soon and will ask him about this, but I’d really appreciate it if you could drop me an e-mail if you have any thoughts on this.

 Many thanks,

Alixana

**

 Hello Alixana,

I always say that bipolar disorder is a classic chicken or the egg scenario.  What comes first? Mania and then a euphoric endorphin rush or a situation that causes happiness and then a mania response?

The answer is complicated. Here are some questions:

– Is it possible you were already slightly manic (hypomanic) which is why dancing was appealing?
– What is the weather like where you live?  Is it still sunny?
– What effects does the dancing have on your sleep?
– Did you meet anyone at the dance you were attracted to?

That is one scenario as all of the above can lead to manic type symptoms.

Almost always, sleep is the most important question when it comes to mania. If you have a wonderful time dancing and come home with your mind swirling-  which is very common for anyone in a fun and stimulating situation- are you able to go to sleep afterwards?  If not, this is a big precursor to more hypomania if you’re already slightly manic. 

I love karaoke, but if I stay out past 11PM, there is simply no way I will sleep so I either go home early or know I will take my sleep meds.  Also, in the past when I would get fantastic news such as a book deal, I would have about three hours to celebrate and then I went straight to depression from the stress. Stress can be something wonderful like dancing- it doesn’t have to be a negative thing. The bipolar brain often can’t differentiate.

In terms of your going to a dancing event and feeling embarrassed, I bet that the others there simply thought you were a fun person! We judge ourselves so harshly- well, depression judges us so harshly.

There is no question you are rapid cycling- going up and down  between what you call the endorphins and then the depression simply wears you out.

I would say that in terms of the chicken and the egg, all of the above is going on with you.  It’s easy to confuse endorphins – a quick rush of hormones that cause a sense of well being- and the over the top feeling of euphoria that comes with hypomania.  There is a difference. Endorphins don’t usually make you do something dumb! They are short lived- hypomania tends to persist after the event.

It’s great you’re going to see your doctor-  I am sure you will discuss sleep as that is the biggest issue here.  I use my treatment plan (the Health Cards) to track all of my moods so that I can see the triggers and know what came first- the mania or the event! I was always confused before I started writing down all of my symptoms.

Bipolar disorder is an extremely complicated illness- simply because our brains and its hormones are so complicated.  There is absolutely no reason you have to stop dancing- but you will have to learn to manage the dancing so that you can stay stable. It’s completely possible.

Thank you for writing,

Julie

Here is the reply from Alixana- it’s so interesting!

Hi Julie,

Thanks so much for your answer. After reading and re-reading what you wrote, I think I’ve figured out what happened. Basically, I’d not been sleeping for more than 48 hours before the party, and prior to that, sleep has been elusive. So I guess I was already well on my way to hypomania, and the party just had enough triggers to tip me over the edge. It’s reassuring to know that dancing per se might not be the problem. Like you mentioned, I must learn how to handle it so that it doesn’t cause any trouble in future.

Thank you so much – your reply gave me a great deal of reassurance.

Much thanks,

Alixana

Hi Julie,

I am going to court tomorrow, and I have been a mess, shaky, anxious, and frustrated at everybody around me.  I feel like everything someone says is just irritating and worthless to me.  I  don’t want to be around anybody, but I know that is not healthy for me. I have been getting worse all week leading up to this stressful situation.  I am worried that I am going to have a full blown depression episode.  I cannot concentrate and am having trouble sleeping.

Hi C,

Isn’t it amazing what stress can do to our bodies and minds… I would be stressed too. It hits us harder- that’s for sure.  It’s amazing that you are aware of your anger and frustration- this means you can keep it from ruining relationships and getting you into trouble. I was majorly irritated yesterday and even yelled at a friend- I felt terrible and then realized that is not the real me and I have to manage myself better. I suggest that you have a mantra to say the rest of the day. I am angry because I am stressed and I have bipolar disorder. I will NOT take this out on other people. They are not the problem. I will NOT ruin relationships. I have made it through many tough things and I will make it through this. I know when the court session is over I will feel differently. I can do this and I will. Now, what do I need to do right now to feel better.

I talk to myself like this constantly- even with the stress is overwhelming. The truth is that you can’t get out of the court situation, so you might as well use it as a learning experience to see how well you can manage the anger.

Julie

I once asked a friend of mine what he thought about mania and his friends with bipolar disorder. It’s always interesting to ask the people in your life how they perceive bipolar  moodswings. It may be very different than you expect. Here is his answer.

**

 I’ve always thought of mania as a “Euphoric” high, the feeling that we
 all have at times that is exacerbated with someone with bipolar
 disorder.  You feel like you can do no wrong, you feel great, you can’t
 believe you’ve ever been depressed.  You can spend money, make big decisions,
 all with this state of mind.  I compare it to making decisions with a
 depressed mind, you don’t want to do that either.  It’s like two ends
 of a spectrum.  It may feel great to be on a manic high, but it seems
 uncontrollable, decisions are made that are easily regrettable in a short
 time.  Like a control chart people have highs and lows, the best time
 to use your mind for rational thought is in the middle, or ‘medium
 high’. You are thinking and listening less when both manic or depressed as
 well.  For some people like my girlfriend who’s a natural speaker, talking
 comes so easy that it’s more difficult to recognize when she’s on a manic
 high.  The best way I could see that she was  manic was her inability to
 listen. 

“Find me some water and I will walk on it” – ancient Chinese proverb.

When I first met my girlfriend, she was manic.  I didn’t recognize it
 of course but I thought I knew enough about bipolar disorder to where I
 thought I could recognize it and deal with it.  When in fact I didn’t
 even recognize her symptoms until much later.  There is no one perfect
 way to deal with it, other than to remind yourself and your friends to
 make decisions with the right frame of mind, and learn what is that
 right frame of mind.  Most people with depression and bipolar can’t even
 see when they are out of there mental ‘sweet spot’.  That’s where
 friends and family come into play to help  those with bipolar disorder
 recognize whether they’re  in a depressed mind, or a manic mind. Then we can help.

**

Interesting.